It’s Not Necessarily Best to Be First

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The finding: People are less likely to choose the highest-rated option in a quality ranking if it appears first on the list.

The research: Working with Anna Dixon, the director of policy for the UK’s King’s Fund, Elena Reutskaja and Barbara Fasolo conducted focus groups on how people selected hospitals for nonurgent care. The team used the answers to design an online experiment that showed people performance scores for actual UK hospitals. The researchers asked participants which hospital they’d choose and tracked their cursor movements through a special tool (which approximated their eye movements) as they read the rankings. More people picked the highest-scoring hospital when it was placed in the middle of a horizontally presented list than when it was placed first.

The challenge: Do consumers have some sort of bias against first place? Professors Reutskaja and Fasolo, defend your research.

Fasolo: You would think that rankings that listed options from highest to lowest quality would help people choose the highest-rated option, but in fact they led people to miss the best-quality option more often than rankings that listed options from closest in distance to farthest and put the best hospital fourth. And this happened with real people choosing between real hospitals, not with participants in a lab.

Why Fourth Is Better

Research shows that people gravitate toward choices in the middle. When given an array of five options, they tend to choose the fourth one.

HBR: How can that be? If you see the top five hospitals listed by quality, wouldn’t you just automatically default to the best one, at the beginning of the list?

Reutskaja: We do see that participants spend more time looking at the first option on the list, whether it is the highest-rated hospital or not. But looking longer at an option does not necessarily mean that participants choose it more often. Overall, people are good at selecting the best option no matter where it’s located on a short list. But they select the best option more often when it’s located in the middle than when it appears first.

Why would I choose something other than the #1 ranked option, especially when I can’t miss it?

Reutskaja: There are at least four possible reasons: One, you just make a mistake. You want to stop at the first option in the quality ranking, but you can’t resist the temptation to search a bit more, and as a result you “oversearch” and stop later than you should, at a lower-quality option. This is a common mistake when people browse online, because it’s so easy to keep browsing. Two, you don’t make a mistake, but you genuinely keep searching for the hospital that best matches your preferences. It just so happens that the option that the web developer or the chart designer or the medical organization thought was the highest quality wasn’t really the best for you. Three, you simply don’t know your preferences because the choice is complex. You don’t have much knowledge about how to choose, so you look at the structure of the comparison chart and consider the “middle” to be a compromise between the best from one point of view (such as quality) and the best on other characteristics. Or four, the middle position is more prominent. For example, in a supermarket, shelf space in the middle, at eye level, is usually more expensive because stores know that shoppers tend to select items from there.

So if you want someone to choose the best hospital, you should put the highest-quality facility in the middle?

Fasolo: Yes—if you present your facilities side by side, as is common on websites, and you have a small number of options. This is what we see in our studies. With five options, the fourth position—middle right—works best. It’s not that people don’t look at all the options. The cursor movements we tracked in our research show that they do. But the middle has something inherently attractive to the human mind. We’re social creatures, and the middle seems like a good and safe place to be, compared with the edges or the top and the bottom. This middle bias shows up in multiple-choice testing, too, where test takers tend to select the middle answer—for example, D from a list of A, B, C, D, and E. We are thinking animals, and our brain extracts information from the structure and pattern of the choice set. The middle has higher chances of containing something good for us, so that’s where we most naturally “forage” for information.

Are there any situations in which we tend not to choose the middle?

Reutskaja: There are situations where people may well want the extreme instead of a choice that feels safe. One example is fashion. In that arena, you may want to stand out. However, even with this example, if a retailer displayed fashionable items side by side, we believe that many people would choose the option in the middle of the horizontal display, simply because of its location.

A knowledgeable decision maker with well-established preferences is also less likely to gravitate toward the middle. She knows exactly what she wants, and the location of that preferred option will have a weaker influence on her choice. However, we rarely know exactly what we want. Moreover, even if we know what we want when we enter a store or a website, oftentimes we change our minds and make another choice on the spot. Our decisions are highly influenced by context. Therefore, designers who present choices need to take into consideration the importance of the middle location when they decide where to place the “best” items in horizontal arrays.

That sounds an awful lot like what advertisers do. It feels like a biased presentation of the information, not a simple nudge.

Fasolo: There’s no such thing as a dispassionate, unbiased presentation of information. For any decision, but particularly for the medical decisions we have researched, people are not dispassionate, nor are they seeking dispassionate information. It’s stressful to choose; when people get anxious, they end up searching for information suboptimally or forgetting. Since we can’t take the stress away, we need to display options in ways that lead patients themselves to make a choice that they won’t regret as poor quality. To designers, the message is clear: Test whether a display helps. Sometimes what we think helps in fact leads people astray.

Is “choice designer” a job? Is it something someone does?

Reutskaja: Many people are choice designers and don’t know it. We know that consumer preferences are not very stable. The way that information is presented will affect them. Choice designers should be aware of how they influence consumers’ decisions. But people should also realize that everyone involved in content development has an impact, from the people who design and write the content to the ones who program it. That’s why you end up with suboptimal choice design. Programmers do one thing. Policy makers do another. Choice design should be teamwork!

Elena Reutskaja is an assistant professor in the marketing department at IESE Business School at the University of Navarra.

Barbara Fasolo is a behavioral decision researcher and senior lecturer in the department of management at the London School of Economics and Political Science.

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